Mandibular repositioning device

ABSTRACT

The present disclosure provides intra-oral devices for repositioning the relationship between upper and lower dental arches. The devices are attached to appliances on molar teeth of each arch and can be reactivated without removal or replacement of substantial components of the device.

BACKGROUND

The field of orthodontics relates to the supervision, guidance and correction of teeth towards proper positions in the oral cavity. Orthodontic therapy generally involves the application of forces to move teeth into a proper bite configuration, or occlusion. One mode of therapy, known as fixed appliance treatment, is carried out using a set of tiny slotted appliances called brackets, which are affixed to at least the anterior, cuspid, and bicuspid teeth of a patient. In the beginning of treatment, a resilient orthodontic appliance known as an archwire is received in each of the bracket slots. The end sections of the archwire are typically anchored in appliances called buccal tubes, which are affixed to the patient's molar teeth.

When initially installed in the brackets and buccal tubes, the archwire is deflected from its original arcuate (or curved) shape, but then gradually returns to this shape during treatment. In this manner, the archwire applies gentle, therapeutic forces to move the teeth from improper positions to proper positions. Taken together, the brackets, buccal tubes, and archwire are commonly referred to as “braces”. Braces are often prescribed to improve dental and facial aesthetics, bite function and dental hygiene. In many instances, a set of brackets, buccal tubes and an archwire is provided for each of the upper and lower dental arches.

Brackets and other components of the fixed appliance system are commonly placed on the labial (i.e., near the patient's lips and cheeks) surfaces of the teeth. In recent decades, advances in the art have enabled brackets to be placed on the lingual surfaces of teeth. Accordingly, the components of the fixed appliance system, including the archwire, are disposed nearer the tongue, providing an attractive, aesthetic alternative as the appliance system is essentially hidden from view. Lingual brackets often have a customized, individual design for every tooth and patient because, other than the labial surfaces of a tooth, the lingual surfaces greatly vary in shape relative to each other so that a “one size fits all” bracket shape typically cannot be used. Exemplary appliance systems that include brackets customized to the lingual surfaces of a dental arch are disclosed in U.S. Pat. No. 7,811,087 (Wiechmann et al.).

During certain stages of treatment, additional intraoral appliances may be prescribed for use in conjunction with fixed appliances to correct particular kinds of malocclusions. For example, some appliances are used to correct Class II malocclusions, such as an overbite where the mandibular first molars are located excessively distal (in the rearward direction) with respect to the maxillary first molars when the jaws are closed. Other appliances remedy an opposite malocclusion, known as a Class III malocclusion, such as an underbite where mandibular first molars are located excessively mesial (in the forward direction) with respect to the maxillary first molars when the jaws are closed.

In recent years, Class II and Class III correctors have been developed that are installed by the orthodontist and require minimal patient intervention during the course of treatment. These devices advantageously correct Class II and Class III malocclusions without need for patient compliance as with prior common head gear. A number of intra-oral devices for correcting Class II and Class III malocclusions are known in the art. For example, U.S. Pat. Nos. 4,708,646, 5,352,116, 5,435,721, 5,651,672, 5,964,588 and 8,257,080 describe intra-oral bite correctors with flexible and/or telescoping members that are connected to upper and lower arches of a patient. A bias tends to urge the members toward a normally straight orientation and provide a force that pushes one dental arch forward or rearward relative to the other dental arch when the jaws are closed.

As the position of the jaws is corrected, that bias is reduced during jaw closure and consequently provides less force in compression. In response, the practitioner may elect to increase the effective, active length of the intra oral device to ensure that the force exerted on the patient's jaws remains effective during the course of treatment. The effective length is typically increased or otherwise modified by removing the intra-oral device from the patient's mouth and then changing the components to continue treatment. Alternatively, stops or collars can be added to such devices to reduce the length of travel and increase the active force supplied.

Moreover, there are various possibilities in connecting these devices to the dental arch. Banded headgear tubes are still commonly used to provide a distal connection to the upper dental arch. These banded appliances, however, are not universally beloved. Bondable molar appliances are more convenient to use with labial systems in many respects and some orthodontists prefer them over banded appliances. As another option, connection to the dental arch may be made indirectly by coupling the intraoral device to one or both archwires.

SUMMARY

Though myriad products and solutions exist for attaching the Class II and Class III correctors to labial braces, the same cannot be said for lingual appliance systems. Typical methods of attachment are reliant on the presence of an archwire and other appliances on the labial surfaces of the patient's dental arches to provide an anchor for the outer end of the corrector. In present lingual appliance systems, the archwire is located proximate the lingual surfaces of the tooth, rendering attachment of the outer end loop impossible without further intervention. Moreover, it can be an advantage to connect such intra-oral devices to the molar teeth of both arches, because the relatively large size of the roots of the molar teeth provides a good anchoring location for applying forces to move one jaw relative to the other jaw.

The present disclosure provides assemblies allowing for secure use of intra-oral devices, particularly bite correctors, with labially or lingually bonded appliance systems. The assemblies serve to reduce the profile of labially attached bite intra-oral devices during use; increasing patient comfort and likely compliance with the prescribed treatment. Furthermore, the assemblies minimize the distance between the attachment mechanisms on each dental arch to ensure molar-to-molar attachment with efficient use of space. Incidentally but advantageously, the molar to molar connection also provides a more aesthetic option for the patient, as the mesial end portion of the connector is positioned at a location more distal relative to the social, anterior teeth.

In one aspect, the present disclosure provides an intraoral assembly configured for moving the relative positions of upper and lower dental arches. The assembly includes a first orthodontic molar appliance adapted for connection to a tooth and a repositioning device comprising an upper module pivotally coupled to a lower module. The upper module includes a telescoping assembly having a first member and a second member slidably coupled to the first member for movement along a reference axis, the second member having an outer end portion. The lower module includes a housing defining a cavity, a portion of the housing extending distally to a second outer end portion along a portion of the length of the telescoping assembly, with the housing segment further including a tension member received in the cavity. The tension member is in tension and extends in length as the upper and lower dental arches are closed.

In another aspect the present disclosure provides an intraoral assembly configured for moving the relative positions of upper and lower dental arches. The assembly includes a first orthodontic molar appliance adapted for connection to a tooth and a repositioning device comprising an upper module pivotally coupled to a lower module. The upper module including a telescoping assembly having a first member and a second member slidably coupled to the first member for movement along a first reference axis, the second member having an outer end portion. The lower module includes an outer housing defining an internal passage, a portion of the housing extending distally to a second outer end portion along a portion of the length of the telescoping assembly, wherein the housing segment includes a tension member coextensive with at least a portion of the outer housing. The tension member is in tension and extends in length as the upper and lower dental arches are closed.

The terms “comprises” and variations thereof do not have a limiting meaning where these terms appear in the description and claims. Such terms will be understood to imply the inclusion of a stated step or element or group of steps or elements but not the exclusion of any other step or element or group of steps or elements. By “consisting of” is meant including, and limited to, whatever follows the phrase “consisting of.” Thus, the phrase “consisting of” indicates that the listed elements are required or mandatory, and that no other elements may be present. By “consisting essentially of” is meant including any elements listed after the phrase, and limited to other elements that do not interfere with or contribute to the activity or action specified in the disclosure for the listed elements. Thus, the phrase “consisting essentially of” indicates that the listed elements are required or mandatory, but that other elements are optional and may or may not be present depending upon whether or not they materially affect the activity or action of the listed elements.

The words “preferred” and “preferably” refer to embodiments of the disclosure that may afford certain benefits, under certain circumstances. However, other embodiments may also be preferred, under the same or other circumstances. Furthermore, the recitation of one or more preferred embodiments does not imply that other embodiments are not useful, and is not intended to exclude other embodiments from the scope of the disclosure.

In this application, terms such as “a”, “an,” and “the” are not intended to refer to. only a singular entity, but include the general class of which a specific example may be used for illustration. The terms “a”, “an”, and “the” are used interchangeably with the term “at least one.” The phrases “at least one of” and “comprises at least one of” followed by a list refers to any one of the items in the list and any combination of two or more items in the list.

As used herein, the term “or” is generally employed in its usual sense including “and/or” unless the content clearly dictates otherwise.

The term “and/or” means one or all of the listed elements or a combination of any two or more of the listed elements.

Also herein, all numbers are assumed to be modified by the term “about” unless specifically stated otherwise. As used herein in connection with a measured quantity, the term “about” refers to that variation in the measured quantity as would be expected by the skilled artisan making the measurement and exercising a level of care commensurate with the objective of the measurement and the precision of the measuring equipment used.

Also herein, the recitations of numerical ranges by endpoints include all numbers subsumed within that range as well as the endpoints (e.g., 1 to 5 includes 1, 1.5, 2, 2.75, 3, 3.80, 4, 5, etc.).

As used herein as a modifier to a property or attribute, the term “generally”, unless otherwise specifically defined, means that the property or attribute would be readily recognizable by a person of ordinary skill but without requiring absolute precision or a perfect match (e.g., within +/−20% for quantifiable properties). The term “substantially”, unless otherwise specifically defined, means to a high degree of approximation (e.g., within +/−10% for quantifiable properties) but again without requiring absolute precision or a perfect match. Terms such as same, equal, uniform, constant, strictly, and the like, are understood to be within the usual tolerances or measuring error applicable to the particular circumstance rather than requiring absolute precision or a perfect match.

As used herein: “Mesial” means in a direction toward the center of the patient's curved dental arch; “Distal” means in a direction away from the center of the patient's curved dental arch; “Occlusal” means in a direction toward the outer tips of the patient's teeth; “Gingival” means in a direction toward the patient's gums or gingiva; “Facial” means in a direction toward the patient's lips or cheeks; and “Lingual” means in a direction toward the patient's tongue.

The above summary of the present disclosure is not intended to describe each disclosed embodiment or every implementation of the present disclosure. The description that follows more particularly exemplifies illustrative embodiments. In several places throughout the application, guidance is provided through lists of examples, which examples can be used in various combinations. In each instance, the recited list serves only as a representative group and should not be interpreted as an exclusive list.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a side elevational view of a repositioning device including both an upper module and a lower module according to an embodiment of the disclosure;

FIG. 2 is a view somewhat similar to FIG. 1 except that the patient's jaws have been fully opened;

FIG. 3 is an illustration of the repositioning device of FIG. 2, with the patient's jaws and teeth omitted;

FIG. 4 is a mesial end view of a pivot link as depicted in FIGS. 1-3;

FIG. 5 is a side elevational view of a repositioning device including both an upper module and a lower module according to another embodiment of the disclosure, with the lower jaw illustrated in a Class I relationship to the upper jaw;

FIG. 6 is a view somewhat similar to FIG. 5 except that the lower jaw is illustrated in a Class II relationship relative to the upper jaw, such that a biasing force presented by a tension member of the device functions to urge the lower jaw forward relative to the upper jaw;

FIG. 7 is a view somewhat similar to FIGS. 5 and 6 except that the patient's jaws have been fully opened;

FIG. 8 is a side elevational view of a repositioning device including both an upper module and a lower module according to another embodiment of the disclosure, with the lower jaw illustrated in a Class I relationship to the upper jaw;

FIG. 9 is a view somewhat similar to FIG. 8 except that the lower jaw is illustrated in a Class II relationship relative to the upper jaw, such that a biasing force presented by a tension member of the device functions to urge the lower jaw forward relative to the upper jaw; and

FIG. 10 is a view somewhat similar to FIGS. 8 and 9 except that the patient's jaws have been fully opened.

While the above-identified figures set forth several embodiments of the disclosure other embodiments are also contemplated, as noted in the description. In all cases, this disclosure presents an invention by way of representation and not limitation. It should be understood that numerous other modifications and embodiments can be devised by those skilled in the art, which fall within the scope and spirit of the principles of the inventions.

DETAILED DESCRIPTION OF EXEMPLARY EMBODIMENTS

An exemplary embodiment of an intraoral appliance system is shown in FIGS. 1 and 2. These figures depict an orthodontic assembly, which is designated herein by the numeral 100, coupled to a set of labial brackets. One skilled in the art will recognize that assembly 100 can also be coupled to a set of lingual brackets. The assembly 100 is installed on the right side of the upper and lower jaws (38, 39) of a patient, which are illustrated in profile. view. As shown, the teeth of the upper jaw 38 include an upper central, upper lateral incisor, upper cuspid, upper first bicuspid, upper second bicuspid, upper first molar 10, and upper second molar 15. Similarly, the teeth of the lower jaw include a lower central, lower lateral, lower cuspid, lower first bicuspid, lower second bicuspid, lower first molar 20 and lower second molar 25.

A number of slotted orthodontic appliances (i.e., brackets) 40 are fixed to the teeth of the patient's upper jaw 38 and an archwire is received in the archwire slot of each appliance. An elastomeric O-ring ligature extends around tiewings of each bracket in order to retain the archwire in the archwire slots of the brackets. Similarly, a number of slotted orthodontic brackets are fixed to the teeth of the patient's lower jaw 39. An archwire is received in the slot of each such bracket. An elastomeric O-ring ligature extends around the tiewings of each bracket in order to retain the archwire in the archwire slots of the brackets. In this example, both upper and lower archwires have generally rectangular cross-sections in planes perpendicular to their longitudinal axes. Other archwire configurations, including ovular and circular cross-sections, are also possible.

The right distal ends of the upper and lower archwires are received in an archwire slot of molar appliances 50, 70, respectively. Optionally, an end section of the archwire is bent as shown in FIGS. 1 and 2 in a location adjacent the distal side of the molar appliance 50, 70. Each bracket and molar appliance includes a base or other surface for bonding the appliance to the facial surface of its respective tooth.

In the illustrated example, the base of the molar appliance is affixed to a band. The band encircles the patient's upper right first molar tooth 10 and is connected to the upper molar appliance 50 by a weld or a braze joint. Optionally, the upper molar appliance 50 may be connected to the molar tooth 10 by other means such as an adhesive bond between the base and the enamel surface of the molar tooth 10. The upper molar appliance 50 has a body that extends outwardly from the base in a generally facial direction and includes an archwire slot 58. As depicted in FIGS. 1 and 2, the appliance 50 is a convertible appliance with a section of material covering a buccal opening of the archwire slot. The body includes a passage 60 adjacent the archwire slot 58. In certain implementation further described herein, the passage 60 is used in coupling a mandibular repositioning device to the upper molar appliance 50. In embodiments featuring a patient with lingual braces, the molar tube appliance need only include a base and tubular passage; the archwire slot will be unnecessary. The lower molar appliance 70 may include some or all of the same features as the upper molar appliance 50 (including convertibility), but will typically include a base, body, archwire slot, and passage.

The force assembly 100 includes a combination of elements that cooperate in applying a therapeutic force between the upper and lower dental arches. In the embodiment shown, the assembly 100 includes an upper attachment device 102, a repositioning device 110, and a lower connector 150.

As shown in more detail in FIG. 2, the attachment device 102 includes a first post that extends through the opening of an end cap 114 on repositioning device 110. The first post is pivotally movable in the opening and enables pivotal movement of the attachment device 102 relative to the repositioning device 110 in an arc about a facial-lingual reference axis. The attachment device 102 also includes a second post that is spaced from and parallel to the first post. A flat, oval-shaped plate 107 is coupled to the outer ends of both posts and serves to retain the attachment device 102 in secure, coupled relationship to the end cap 114.

The attachment device 102 typically includes at least one resilient portion that enables the attachment device 102 to couple to the upper molar tube appliance 50 in a “snap-fit” relationship. This “snap-fit” relationship is similar to the “snap-fit” relationship described in connection with the orthodontic attachment modules and couplings described in U.S. Pat. No. 6,913,460 (Cleary et al.) and U.S. Pat. No. 8,714,974 (Cleary). The resilient portions tend to hold the attachment device 102 in place and in a captive relationship to the molar tube appliance 50 during the course of treatment, but also enable the attachment device 102 to be disconnected from the molar tube appliance 50 when desired.

Additional aspects and alternative constructions regarding the attachment device 102 are set out in the aforementioned U.S. Pat. No. 8,714,974 (Cleary), particularly the connectors depicted in FIGS. 11 and 12 of that application. As additional alternatives, a force module 110 may be coupled to the upper arch by the connector described in US Publication No. 2012/0028207 (Cleary et al.), which features connectors coupled to an upper wire between the upper second bicuspid bracket and the upper molar tube. In operation, such alternative connectors slide distally along the wire until bearing against the mesial side of molar tube, while the third member of a force module slides mesially along the lower archwire until it bears against the distal side of a lower arch bracket.

The orthodontic assembly 100 including a mandibular repositioning device 110 and a rotatable connector 180 is depicted in FIGS. 1-3. The device 110 includes an upper module 112 and a lower module 140. In the illustrated embodiment, the upper module 112 features a telescoping assembly. The lower module 140 includes a spring housing 142 and a coil spring 148. The telescoping assembly may, in other embodiments, share aspects of the devices described in U.S. Pat. No. 6,988,888 (Cleary). As depicted in FIGS. 1 and 2, the upper attachment device 102 is coupled to the passage 60 in the upper molar appliance 50. On opposite arch, the force module 110 is coupled to the lower connector 150, which is itself coupled to the lower molar appliance 70.

The telescoping assembly includes a hollow first member 113 having a tubular, elongated shape. A distal outer end portion of the first member 113 includes an end cap 114 with a coupling to enable connection of the upper module 112 to an attachment device 102. A lower end portion of the first member 113 is radially narrowed and presents an inner diameter that is less than the inner diameter of the enlarged upper end of the first member 113. The telescoping assembly also includes a second member 120 received at least partially in the first member 113 for sliding movement in a longitudinal direction along the central, longitudinal axis of the first member 113. In this embodiment, the second member 120 has a solid, circular cross-sectional configuration along its longitudinal axis, although other configurations are also possible.

A distal end portion of the second member 120 is radially enlarged in stepped fashion, such that the enlarged upper end of the second member 120 cannot slide past the lower, narrowed end portion of the first member 113 and as a result a limit to outward travel is provided. This relationship operates to retain the members in an assembled state.

In certain embodiments, the second member 120 can include one or more collars 129 that are fixed in place relative to a mesial outer end segment 122. The collar 129 can limit the extent of movement of the second member 120 by engaging the lower end of first member 113 when the patient's jaws are nearly fully compressed.

The outer mesial end 122 of the second member 120 is secured in a pivot link 130, which includes an upper segment 131 including a mesial-distal extending recess 132 and a lower segment 133 also including a mesial-distal recess. 136. A hinge 134 is disposed between the segment 131, 133 and has an axis of rotation extending in a generally facial-lingual direction (i.e., generally perpendicular to the longitudinal axis of first and second members 113, 120). In the depicted embodiments, the outer mesial end 122 remains essentially fixed relative to recess 132 during use of the device 110. As best illustrated in FIG. 4, the upper and lower segments 131, 133 are offset on a facial-lingual axis from the hinge 134. Accordingly, the upper segment 131 and recess 132 are disposed in a generally facial direction from the lower segment 133 and recess 136. Hinge 134 may be created by a rivet, pin, or like structure 138 that extends through a portion of upper and lower pivot segments 131, 133. As another example, the hinge 134 may comprise a machine screw and threaded nut which optionally may be disconnected for separation of the modules 112, 140 as desired. Other types of pivots and hinges may also be employed to ensure the appropriate connection and rotation.

In certain implementations, the outer mesial end 122 is permanently secured in the recess 132 via adhesive, soldering composition, or the like. In other implementations, the second member 120 is removably secured to the pivot link 130, such that the second member 120 can be replaced or modified (e.g., by inclusion of additional sliding collars 29 adjacent mesial end 122) as desired during treatment. A removable connection between the second member 120 and the passage 132 can allow a treating practitioner to change the activation length of the force module 110 as desired.

The lower module 140 includes a spring housing 142 that extends distally from the pivot link 130 along a longitudinal axis that is generally parallel to the longitudinal axis of the telescoping assembly 112 when the assembly is in the compressed configuration of FIG. 1. The mesial outer end 143 includes a recess 144 that is coaxial with a similarly dimensioned recess 146 on the distal outer end coupling 145. In presently preferred circumstances, the spring housing 142 has a generally rectangular cross-section as it extends toward distal end coupling 145. In other implementations, the spring housing 142 may comprise circular, ovular, square, or other cross-sectional geometries along its longitudinal axis.

A helical coil spring 148 is disposed in the cavity 147 between the recesses 144, 146 and coaxially extends around a cylindrical plunger 149. One end of the coil spring 148 bears against the mesial outer segment 143, while the other end is adjacent a collar 150 coupled to the plunger 149. The cylindrical plunger 149 is received in both the mesial and distal recesses 144, 146 and; in presently preferred circumstances, the plunger is removably fixed in the cavity 147, though other alternatives are possible. The cylindrical plunger 149 also serves to connect the spring housing 142 to the central pivot link 130, as it is fixedly received in recess 136 and renders the three recesses (136, 144, 146) generally concentric as assembled. The spring 148 is illustrated in its nearly fully compressed position in FIG. 1 and in an extended position in FIGS. 2 and 3. As can be appreciated, the spring is movable relative to both the plunger 149 and the housing 142.

The spring housing 142 includes a distal end coupling 145, which is configured to permit rotatable attachment of the lower module 140 to the lower connector 180. Such connection may be accomplished through a rivet pin, threaded screw, or any other mechanism for pivotal attachment including those described above, which allows for controlled rotation of the lower module 140 relative to the patient's lower arch. The end coupling 145 includes an aperture that can be aligned with a central aperture on lower connector 180. A rivet can be pressed through the aligned apertures to secure the respective components. As another example, one or both apertures may include interior threads, allowing a screw having corresponding threads to couple the lower connector 180 and the spring housing 142. The rivet can cover a portion of the distal end coupling 145 in order to releasably retain the spring housing 142 in connected relation to the connector 180. In presently preferred iterations, the rivet and both the apertures on the lower connector 180 and spring housing 142 have circular cross-sectional shapes, allowing a rotational connection to be established between the connector 180 and the spring housing 142. Additional aspects of the coupling between connector 180 and spring housing 142 may be found in Applicant's co-pending application having Application No. 62/095,909 and entitled “Orthodontic Auxiliary and Connector with Modifiable Activation Parameters” (Attorney Docket No. 75159US002).

The lower connector 180 includes a base plate 182 and a coupling wall segment that extends in a lingual direction at an angle of generally 90 degrees relative to the plane of the base plate 182; this presents a “L”-shape in cross-section. Both the base plate 182 and the wall can include apertures used to align and couple the connector to the spring housing 142 and the lower molar appliance 70, respectively. The base plate 182 is generally planar and can extend across at least portion of the facial surfaces of the lower molar appliance 70 when secured thereto. The connector 180 can be removably secured to the lower molar appliance 70 via a pin including a shank that is threaded through the aperture in a connecting wall segment a passage in the lower appliance. However, other types of coupling, such as links or wire loops, may be used in place of the pin. Alternatively, the coupling wall segment (or portion of the base plate 182) may be adhered, soldered, or brazed to the lower molar appliance.

The connector 180 includes first and second arcuate channels 186, 188 in a base plate 182. The first and second channels 186, 188 are positioned on either side of a central aperture, proximate opposing mesial-distal edge regions of the base plate. Each channel 186, 188 includes occlusal and gingival ends to limit rotational movement of the lower module 140 in an arc about the base plate 182. The channels 186, 188 can extend at least partially through the facial-lingual thickness of the base plate 182, though typically both have the same facial-lingual depth. The channels 186, 188 each include occlusal and gingival ends to limit rotational movement of the lower module 140 in an arc about the base plate 182 that is in the range of about 20 degrees to about 70 degrees, in some embodiments 25 degrees to about 60 degrees, and in certain implementations is in the range of about 30 degrees to about 50 degrees. These limits can prevent the lower module 140 from interfering with the patient's soft, gingival tissue when the patient's jaws are closed and can prevent mesial-distal reversal or destruction of the pivot link as patient's jaws are opened. Additional aspects of the connector 180, as well as alternative connectors featuring a single channel, may be found in Applicant's co-pending application having Application No. 62/095,909 and entitled “Orthodontic Auxiliary and Connector with Modifiable Activation Parameters” (Attorney Docket No. 75159US002).

The connector 180 may be secured to the outer end of the spring housing 142 by the manufacturer or optionally by the practitioner. For example, it may be preferable for the manufacturer to supply the spring housing 142 in two or more different overall lengths in order to allow the practitioner to choose a size that would best fit the oral cavity of a particular patient. In that case, the manufacturer may elect to permanently secure a connector 180 to the distal end coupling 145 of the spring housing 142.

The spring housing 142 further includes a rotation stop 160 for coupling to arcuate channels 186 and 188 in connector 180. The rotation stop 160 includes an elongated shaft 162 and a stop pin 164, though other configurations are possible. One end of the shaft 162 is secured proximate the mesial outer segment 143. A portion 165 of the shaft 162 extends along the surface of spring housing 142 parallel to and co-extensive with at least a portion of the cylindrical rod 149. A distal portion 166 of the shaft 162 extends at an angle relative to first portion 165, positioning the stop pin 164 towards the gingival end of channel 186, allowing for greater rotation of the stop pin 164 within the connector 180 when the requisite components are assembled. The shaft 162 is preferably made from a resilient material (e.g., nickel-titanium alloy), allowing the rotation stop 160 to be moved in a generally facial direction and self-return to a generally planar configuration. The resiliency tends to hold the stop pin 164 in place and in a captive relationship to the channel 186 during the course of treatment, but also enables the pin 164 to be disengaged when desired. This reversible engagement between the stop pin 164 and the channel 186 allows for different lower molar appliance connectors or connector orientations to be used during the course of treatment.

The spring constant of the spring 148 is selected so that the spring begins to extend whenever the force exerted by the upper module 112 in a generally mesial direction exceeds a certain amount. An example of a suitable spring is a spring that begins to extend whenever the tensile forces exerted on the spring exceed approximately 0.5 lbs (0.2 kg) and, when extended by 0.1 inch (2.5 mm), exerts a tensile force of approximately 2 lbs (0.9 kg). However, springs that are stronger or weaker may also be employed in accordance with the particular treatment program and/or the particular orthodontic appliances and other components selected by the practitioner.

Advantageously, the repositioning device 110 does not provide a hard, solid stop when the jaws are closed. Instead, the spring 148 provides a gradual increase in tension force as the jaws close. Such construction helps to ensure that the forces imposed on various components of the force assembly 100 are not excessive and do not cause fatigue or fracture. In addition, such construction helps ensure that the other various tooth attachments, including the brackets and the buccal tubes, remain firmly connected to the teeth.

As shown in FIG. 1, the repositioning device 110 is in its nearly fully compressed configuration when the patient's jaws are closed. In this nearly fully compressed configuration, the upper and lower modules 112, 140 are generally parallel to the occlusal plane of the patient and the spring 148 is almost but not fully compressed. The inherent bias of the spring 148 provides the desired corrective forces by urging the lower molar appliance 70 in a direction toward the mesial end segment 143, with the result that the lower jaw tends to shift in a forward direction relative to the upper jaw. When the patient's jaws are closed, the stop pin 164 can engage a gingival end of the channel 186, and prevents further swinging movement of the module 110 in a clockwise direction viewing FIG. 1 from its illustrated orientation.

As the patient's jaws are opened as in FIG. 2, the spring housing 142 rotates relative to connector 150 until such time as the stop pin 164 engages the occlusal end of channel 186. Assuming the second member 120 has reached the end of its permissible travel, the connector 180 and cooperating rotation stop 160 will serve to prevent or at least dissuade the patient from further opening the jaws. Without such a limit on third segment 142 rotation, the pivot link 130 could be thrust distally towards the back of the mouth if the patient's jaws are positioned too far apart. Such mesial-distal reversal could significantly interrupt treatment, compromise one or more components of the orthodontic assembly 100, and cause severe discomfort for the patient.

The assembly 100 accordingly provides several advantages:

1) The module is securable to both the upper and lower arch without use of an archwire or other anterior orthodontic appliances. Only molar appliances are necessary, making force module 110 particularly well suited for use with lingual braces.

2) A molar to molar attachment combined with active forces provides a more compact treatment device.

3) Module components reduce or prevent excess rotation, but still allows for the patient to open and close mouth under common circumstances without substantial irritation.

Over a period of time, the force module 110 shifts the jaws toward a permanent Class I relationship. As the position of the jaws is corrected, the spring 148 is not extended as far during jaw closure and consequently provides less force in compression. In response, the practitioner may elect to increase the effective, active length of the repositioning device 110 to ensure that the force exerted on the patient's jaws remains effective. The effective length (and accordingly active and/or repositioning force) may be increased (or decreased if desired) by removing the repositioning device 110 from the patient's mouth and then changing the second member 120 or the spring 148. Alternatively, the practitioner can crimp on one or more stop collars to the second member 120 adjacent the pivot link 130, so that the second member 120 does not slide as far into first member 113 when the patient's jaws are closed. Suitable stop members may be found, for example, in U.S. Pat. No. 6,589,051 (Cleary), though other configurations are possible.

The availability of two, offsetting channels 186, 188 in the lower connector 180 also allows for the effective length of repositioning device 110 to be increased by changing the position of the spring housing 142 relative to lower molar appliance 70. At an initial configuration, the central aperture and channel 186 extend over at least some of the facial surfaces of the lower molar appliance 70, providing a connection point for the third segment 142 and a certain mesial distal distance between the upper and lower modules. As the position of the jaws is corrected (i.e., the lower jaw moved to a Class I relationship with the upper jaw), the activation length of the repositioning device 110 may be increased by moving that connection point distally. Rotation of connector 180 is possible without disassembling any other component of the repositioning device 110. This simplified reactivation process reduces time needed with a patient, as the practitioner need not remove or replace the repositioning device. Furthermore, the potential risk to the patient is reduced, as fewer small components are disassembled and potentially free in the mouth.

Another embodiment of an orthodontic assembly 200 including a mandibular repositioning device 210, an upper connector 202 and a lower connector 280 is depicted in FIGS. 5-7. The labial brace is omitted for ease of reference. The mandibular repositioning device 210 includes an upper module 212 and a lower module 240 pivotally coupled through pivot link 230. Those skilled in the art will perceive that certain functional elements of upper module 112, pivot link 130, and connector 180 apply mutatis mutandis to upper connector 202, upper module 212, pivot link 230, and connector 280, and need not be repeated at length here. The connector 280, however, is not rotatable in the same manner as connector 180. Additional aspects of this lower connector 280 may be found in Applicant's co-pending application having Application No. 62/095,909 and entitled “Orthodontic Auxiliary and Connector with Modifiable Activation Parameters” (Attorney Docket No. 75159US002).

The lower module 240 includes an outer housing 242 and a telescoping plunger 249 that is received in the outer housing 242. The lower module 240 extends distally from the pivot link 230 along a longitudinal axis that is generally parallel to the longitudinal axis of the telescoping assembly 212 when the assembly is in the compressed configuration of FIGS. 5 and 6. The outer housing 242 is an at least partially hollow structure having a circular, elongated shape and includes an enclosed passage 246 extending through the structure. The outer housing 242 has a generally circular cross-section as it extends toward distal end coupling 245. In other implementations, the housing 242 may comprise rectangular, ovular, square, or other cross-sectional geometries along its longitudinal axis.

The telescoping plunger 249 is received in an enclosed passage 246 for sliding movement in a longitudinal direction along the central, longitudinal axis of the outer housing 242. In this embodiment, the plunger 242 has a solid, circular cross-sectional configuration along its longitudinal axis, although other configurations are also possible. In presently preferred circumstances, the plunger 249 is removably fixed in the passage 246, though other alternatives are possible. The plunger 249 also serves to connect the outer housing 242 to the central pivot link 230, as it can be fixedly received in recess 236 and serves to render the passage 246 and the recess 236 generally concentric as assembled.

Like telescoping upper module 212, a distal end portion of the telescoping plunger 249 can be radially enlarged in stepped fashion, such that the enlarged upper end of the plunger 249 cannot slide past a lower, narrowed end portion of the passage 246 and as a result a limit to outward travel is provided and the members are retained in an assembled state.

A tension member 250 in the form of an elastic power chain extends along the gingival surfaces of the outer housing 242. Unlike the relationship between the plunger 149 and tension member 150, the power chain 250 is not coaxial with and arranged about the plunger 249. The power chain includes several, generally circular apertures 252, which allow the power chain 250 to be secured to lower module 240 and pivot link 230. In the depicted embodiment, the distal end 245 of the outer housing 242 and the lower segment 233 of pivot link 230 each include a hook 260, 262 extending in a generally gingival direction. The hook 260 protruding from the outer housing 242 includes a distally extending portion 261, while the hook 262 extending from the pivot link 230 includes a mesially extending portion 263. Securing one end of the power chain 250 to the pivot link 230 allows for the telescoping movement between the outer housing 242 and plunger 249 during treatment, as further described below.

The elastomeric power chain can typically include a polyurethane, nitrile rubber, ethylene propylene diene monomer (EPDM) rubber, styrenic block copolymers (e.g., styrene-butadiene-styrene, styrene-ethylene/butadiene-styrene and styrene-isoprene), or combinations thereof. Examples of other materials used in elastomeric dental articles are disclosed, for example, in U.S. Pat. No. 5,317,074 (Hammar et al.). Examples of elastomeric orthodontic force modules include a polyester-based urethane or a polyether-based urethane.

The elastic properties of the power chain 250 are selected so that the power chain 250 begins to extend whenever the force exerted by the upper module 212 in a generally mesial direction exceeds a certain amount. An example of a suitable tension member 250 is one that begins to extend whenever the tensile forces exerted on the power chain 250 exceed approximately 0.5 lbs (0.2 kg) and, when extended by 0.1 inch (2.5 mm), exerts a tensile force of approximately 2 lbs (0.9 kg).

FIG. 5 is an illustration of the patient's oral cavity when the jaws 38, 39 are closed and postured in a Class I relationship. In this position of the jaws 38, 39, relatively little force is exerted on the repositioning device 210 and the power chain 250 is not extended to any appreciable extent. To this end, the mesial-distal distance between hooks 260, 262 is designed and adjusted as needed by the practitioner or manufacturer so that little, if any, extension of the power chain 250 occurs when the jaws 39, 40 are in proper Class I relationship.

FIG. 6 is an illustration that also shows the jaws 38, 39 closed, but in this instance the lower jaw 39 has postured back to a Class H relationship relative to the upper jaw 38. The upper module 212 and plunger 249 remain in position relative to the upper jaw. The connector 280 and outer housing 242 have moved distally with the lower jaw 39, and causing the plunger to partially emerge from the passage 246 and elongating the power chain 250. The elongation of the power chain 250 increasing its applied force on components of the lower module 240. The applied, biasing tension force presented by the power chain 250 urges the lower appliance 70 in a direction toward pivot link 230, with the result that the lower jaw 39 tends to shift in a forward direction relative to the upper jaw 38.

As the patient's jaws are opened as in FIG. 7, the lower module 240 rotates relative to connector 280 until such time as, e.g., a projection or other structure on the lingual surface of the outer housing 242 bears against an occlusal edge of the connector 280. Assuming the components of the upper module have reached the end of permissible travel, the connector 280 and outer housing 242 will serve to prevent or at least dissuade the patient from further opening the jaws.

As the position of the jaws is corrected, the tension member 250 is not extended as far during jaw closure and consequently provides less force in compression. In response, the practitioner may elect to increase the effective, active length of the repositioning device 210 to ensure that the force exerted on the patient's jaws remains effective. The effective length (and accordingly active and/or repositioning force) may be increased (or decreased if desired) by removing the repositioning device 210 from the patient's mouth and then changing at least one of the second member 220, plunger 249, and the power chain 250. Alternatively, the practitioner can crimp on one or more stop collars to the plunger in the space between the outer housing 242 and the pivot link 230, or between second member 220 and pivot link 230.

Another embodiment of an orthodontic assembly 300 including a mandibular repositioning device 310, an upper connector 302 and a lower connector 380 is depicted in FIGS. 8-10. The mandibular repositioning device 310 includes an upper module 312 and a lower module 340 pivotally coupled through pivot link 330. Those skilled in the art will perceive that certain functional elements of upper connector 202, upper module 212, lower module 240, pivot link 230, and connector 280 apply mutatis mutandis to upper connector 302, upper module 312, lower module 340, pivot link 330, and connector 380, and need not be repeated at length here.

In the assembly 300, the tension member 350 comprises a helical coil spring extending along the gingival surfaces of the outer housing 342. The helical spring 350 includes a distal end segment 352 coupled to hook 360 on the outer housing 342 and a mesial end segment 354, remote from the distal end segment, coupled to hook 362 on pivot link 330. As shown, the end segments 352, 354 are looped around the respective hooks, but other methods of coupling (e.g., soldering) are possible. The spring 350 is illustrated in its nearly fully compressed position in FIGS. 8 and 10 and in an extended position in FIG. 9. As can be appreciated, the spring 350 is extensible relative to both the plunger 349 and the housing 342.

FIG. 8 is an illustration of the patient's oral cavity when the jaws 39, 40 are closed and postured in a Class I relationship. In this position of the jaws 39, 40, relatively little force is exerted on the repositioning device 310 and the coil spring 350 is not extended to any appreciable extent. To this end, the mesial-distal distance between hooks 360, 362 is designed and adjusted as needed by the practitioner or manufacturer so that little, if any, extension of the coil spring 350 occurs when the jaws 39, 40 are in proper Class I relationship.

FIG. 9 is an illustration that also shows the jaws 38, 39 closed, but in this instance the lower jaw 39 has postured back to a Class 11 relationship relative to the upper jaw 38. The upper module 312 and plunger 349 remain in position relative to the upper jaw 38 and pivot link 330. The connector 380 and outer housing 342 have moved distally with the lower jaw 39, and causing the plunger to partially emerge from the passage 346 and elongating the coil spring 350. The elongation of the spring 350 increasing its applied force on components of the lower module 340. The applied, biasing tension force presented by the spring 350 urges the lower molar appliance 70 in a direction toward pivot link 330, with the result that the lower jaw 39 tends to shift in a forward direction relative to the upper jaw 38.

As the position of the jaws is corrected, the tension member 350 is not extended as far during jaw closure and consequently provides less force in compression. In response, the practitioner may elect to increase the effective, active length of the repositioning device 310 to ensure that the force exerted on the patient's jaws remains effective. The effective length (and accordingly active and/or repositioning force) may be increased (or decreased if desired) by removing the repositioning device 310 from the patient's mouth and then changing at least one of the second member 320, plunger 349, and the spring 350. Alternatively, the practitioner can crimp on one or more stop collars to the plunger in the space between the outer housing 342 and the pivot link 330, or between second member 320 and pivot link 330.

Components of the assemblies 100, 200, and 300 may be manufactured according to any number of methods known to the skilled artisan. These methods include, but are not limited to, milling, investment casting, metal injection molding, and rapid prototyping. In presently preferred circumstances, all of the elements of the force modules and repositioning devices (including connectors, rotatable or otherwise) of the present disclosure are made of corrosion resistant materials that provide satisfactory service in the oral environment. Suitable materials include, for example, stainless steels such as AISI 300 series types (including 302 or 304), although other materials may also be employed, such as ceramics, polymers, or composites. If polymeric components are used, these may optionally be formed by milling, injection molding, extrusion or additive manufacturing. Examples of suitable additive manufacturing processes include solid freeform fabrication such as 3D printing processes, stereolithography methods, fused deposition modeling, laminated object manufacturing, laser engineered net shaping, selective laser sintering, shape deposition manufacturing, selective laser melting, and solid ground curing. An example of a suitable 3D printing machine is the Eden brand 500V printer from Objet Geometries Ltd., using FullCure 720 acrylic-based photopolymer printing material (also available from Objet Geometries Ltd.).

Although not shown in the drawings, the force modules, repositioning devices, and attendant orthodontic assemblies described herein are normally used in pairs. While the figures depict the orthodontic assemblies in place along the right side of a patient's oral cavity, a second assembly that is similar to the depicted orthodontic assemblies in mirror image is typically installed along the left side of the patient's oral cavity. In this manner, a balanced amount of force is presented along both sides of the patient's jaws for repositioning the dental arches as desired.

The complete disclosures of the patents, patent documents, and publications cited herein are incorporated by reference in their entirety as if each were individually incorporated. Various modifications and alterations to this disclosure will become apparent to those skilled in the art without departing from the scope and spirit of this disclosure. It should be understood that this disclosure is not intended to be unduly limited by the illustrative embodiments and examples set forth herein and that such examples and embodiments are presented by way of example only with the scope of the disclosure intended to be limited only by the claims set forth herein as follows. 

We claim:
 1. An intraoral assembly configured for moving the relative positions of upper and lower dental arches, the assembly comprising: a first orthodontic molar appliance adapted for connection to a tooth; and a repositioning device comprising an upper module pivotally coupled to a lower module, wherein the upper module including a telescoping assembly having a first member and a second member slidably coupled to the first member for movement along a reference axis, the second member having an outer end portion, the lower module including a housing defining a cavity, a portion of the housing extending distally to a second outer end portion along a portion of the length of the telescoping assembly, wherein the housing segment includes a tension member received in the cavity, and wherein the tension member is in tension and extends in length as the upper and lower dental arches are closed.
 2. The intraoral assembly of claim 1, wherein the tension member is a coil spring.
 3. The intraoral assembly of claim 1, wherein the housing further includes a plunger received in the cavity, and wherein the tension member is coaxial with the plunger.
 4. The intraoral assembly of claim 1, and further including a pivot link coupling the upper and lower modules, the pivot link including a first passage receiving the outer end portion of the second member.
 5. The intraoral assembly of claim 4, wherein the housing further includes a plunger received in the cavity, and wherein a mesial outer end of the plunger is received in a second passage of the pivot link.
 6. The intraoral assembly of claim 5, wherein the tension member is coaxial with the plunger.
 7. The intraoral assembly of claim 1, wherein the tension member is an elastic chain featuring a plurality of apertures.
 8. The intraoral assembly of claim 1 and further including a connector for coupling the lower module to a second orthodontic molar appliance, wherein the lower module is movable in an arc relative to the first connector about a first axis that is generally perpendicular to the reference axis.
 9. The force module of claim 7, wherein the rotatable first connector includes a first channel having an arcuate axis, the channel defining an axis of rotation for the lower module.
 10. An intraoral assembly configured for moving the relative positions of upper and lower dental arches, the assembly comprising: a first orthodontic molar appliance adapted for connection to a tooth; and a repositioning device comprising an upper module pivotally coupled to a lower module, wherein the upper module including a telescoping assembly having a first member and a second member slidably coupled to the first member for movement along a first reference axis, the second member having an outer end portion, the lower module including an outer housing, a portion of the housing extending distally to a second outer end portion along a portion of the length of the telescoping assembly, wherein the housing segment includes a tension member coextensive with at least a portion of the outer housing, and wherein the tension member is in tension and extends in length as the upper and lower dental arches are closed.
 11. The intraoral assembly of claim 10, and further including a pivot link coupling the upper and lower modules, the pivot link including a first passage receiving the outer end portion of the second member and a second passage, and wherein the tension member is attached to the pivot link.
 12. The intraoral assembly of claim 11, wherein the housing further includes an internal passage and a plunger movably received in the passage, and wherein a mesial outer end of the plunger is received in the second passage.
 13. The intraoral assembly of claim 12, wherein the plunger is configured for sliding movement in a generally mesial-distal direction along a longitudinal axis of the outer housing.
 14. The intraoral assembly of claim 10, wherein the tension member is an elastic chain featuring a plurality of apertures.
 15. The intraoral assembly of claim 10, wherein the tension member is a helical spring. 